Aratani Sae, Matsunobu Takeshi, Shimizu Akira, Okubo Kimihiro, Kashiwagi Tetsuya, Sakai Yukinao
Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, JPN.
Division of Cancer Cell Biology, Institute of Medical Science, University of Tokyo, Tokyo, JPN.
Cureus. 2021 Jun 18;13(6):e15736. doi: 10.7759/cureus.15736.
Background Despite the abundant experience of tonsillectomy with steroid pulse therapy (TSP) for patients with immunoglobulin A (IgA) nephropathy, the therapeutic efficacy of TSP on renal prognosis remains controversial. The purpose of this study was to evaluate the efficacy of whether TSP effectively prevents chronic kidney disease (CKD) progression. Methods This was a single-center, retrospective observational study. A total of 149 patients were enrolled in the current study who were confirmed with IgA nephropathy by renal biopsy between February 2011 and August 2019. The impact of TSP on CKD progression was compared with conservative treatment during a follow-up period of 3 years. Results In total, 110 patients received TSP and 39 patients received conservative treatment. There were no differences between the two groups in the initial CKD stages: 65.1% of patients had CKD G1-2, 32.2% had CKD G3, and 2.7% had CKD G4-5. The initial urine protein was 0.7 g/gCr, which was not different between the two groups. Kaplan-Meier analysis showed that patients with TSP had a significantly better renal prognosis than those in the conservative treatment group after one and a half years (p = 0.007). Multivariable analysis revealed that TSP had a significant impact on the prevention of CKD progression, with an adjusted odds ratio of 0.07 (95% confidence interval, 0.01-0.87; p=0.039). However, we could not confirm the predictive value of the Oxford Classification on TSP efficacy. Additionally, the initial urinary protein level was a risk factor for CKD progression. Conclusions TSP was associated with a lower risk of CKD progression. In this regard, our study supports that TSP may be a reasonable treatment option for patients with IgA nephropathy. In the featured study, it needs to be elucidated which histopathological classifications benefit from TSP treatment.
背景 尽管对于免疫球蛋白A（IgA）肾病患者采用扁桃体切除术联合类固醇脉冲疗法（TSP）已有丰富经验，但TSP对肾脏预后的治疗效果仍存在争议。本研究的目的是评估TSP是否能有效预防慢性肾脏病（CKD）进展。方法 这是一项单中心回顾性观察研究。共有149例患者纳入本研究，这些患者于2011年2月至2019年8月期间经肾活检确诊为IgA肾病。在3年的随访期内，将TSP对CKD进展的影响与保守治疗进行比较。结果 总共110例患者接受了TSP治疗，39例患者接受了保守治疗。两组在初始CKD分期方面无差异：65.1%的患者为CKD G1-2期，32.2%为CKD G3期，2.7%为CKD G4-5期。初始尿蛋白为0.7 g/gCr，两组之间无差异。Kaplan-Meier分析显示，TSP治疗的患者在一年半后肾脏预后明显优于保守治疗组（p = 0.007）。多变量分析显示，TSP对预防CKD进展有显著影响，调整后的优势比为0.07（95%置信区间，0.01-0.87；p = 0.039）。然而，我们无法证实牛津分类法对TSP疗效的预测价值。此外，初始尿蛋白水平是CKD进展的一个危险因素。结论 TSP与较低的CKD进展风险相关。在这方面，我们的研究支持TSP可能是IgA肾病患者的一种合理治疗选择。在特色研究中，需要阐明哪些组织病理学分类从TSP治疗中获益。
